Shadese Lisa Griffith-McClellan, LCSW-A,MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P015291 Issued in NC

Practice address

125 Overhill Dr Ste 105
Mooresville, NC 28117-8232

Phone

(980) 430-9205

Fax

(704) 799-8949

NPI assigned

Jan 4, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Daymark Recovery Services, Inc.

  • Multi-Specialty Clinic/Center
  • Concord, NC
  • NPI 1558329243

  Clinical

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, NC

  Medicare reassignment NPD
• Northern Piedmont Counseling PLLC

  • Mental Health Counselor
  • Mooresville, NC
  • NPI 1740689538

  Clinical

  NPD
• Overflow Mental Health PLLC

  • Clinical Social Worker
  • Statesville, NC
  • NPI 1194672741
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1104163625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 PHILLIPS LN",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254747",
            "telephone_number": "646-938-9097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 OVERHILL DR STE 105",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178232",
            "telephone_number": "980-430-9205",
            "fax_number": "704-799-8949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1033 Phillips Ln",
            "address_purpose": "LOCATION",
            "city": "Statesville",
            "state": "NC",
            "postal_code": "286254747",
            "country_code": "US",
            "telephone_number": "646-938-9097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIFFITH-MCCLELLAN",
        "first_name": "SHADESE",
        "middle_name": "LISA",
        "credential": "LCSW-A,MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-04",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-A -21455",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P015291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104163625",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janine L Gregoloff, PA-C
• Jamie Nicole Gregory
• Taryn Ann Greiner, CCC-SLP
• Laura L. Grier, DDS
• Lauren Grier
• Marisa Ann Grimmius, MA, LCMHCA, NCC
• Sarah Groff, LPC
• Andrew Francis Leigh Gross, M.D.
• Nicole Gross
• Stefanie Elizabeth Gross, D.C

• Clinical Social Worker in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.